David L. Knowlton is president and CEO of the New Jersey Health Care Quality Institute.

Poor scores in these quality measures now result in government penalties that can hit hospitals hard.

And as health care evolves and hospitals stretch beyond their own walls, nurses are leading the programs that bring health care into communities. They are critical to the success of health reform as more Americans obtain health insurance and seek primary care.

So tell me something? Why is the highest level of hospital leadership in our nation nearly devoid of nurses?

Surveys find the number of nurses with voting positions on hospital boards is about 4 to 6 percent — an unfathomable statistic for anyone who understands, even a little, how hospitals work.